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General NPI Number Information
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NPI Number | 1609107457
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Entity Type | Individual
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Provider Name | VANESSA MARCY WINOKUR PA-C
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Gender | Female
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Dates
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Enumeration Date | 01/19/2010
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Last Update Date | 06/25/2012
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Provider Practice Location Address
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Address Line | 210 VILLAGE CENTER PKWY
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City | STOCKBRIDGE
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State | GA
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Zip | 30281-9044
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Country | US
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Telephone | 770-474-5952
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Fax | 770-474-2187
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Provider Business Mailing Address
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Address Line | 3790 W NANCY CREEK CT NE
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City | ATLANTA
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State | GA
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Zip | 30319-1629
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Country | US
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Telephone | 678-637-9580
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 003607
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License Number State | GA
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